SELF-EXPANDABLE METAL STENTS FOR MALIGNANT DYSPHAGIA

• Published in: Australian and New Zealand Journal of Surgery Vol. 69; no. 9; pp. 668 - 671
• Main Authors: Lam, YUK H., Chan, Angus, Lau, James, Lee, Danny, Ng, Enders, Wong, Simon, Chung, Sydney
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Science Asia Pty. Ltd 01.09.1999
• Subjects: Adenocarcinoma - chemically induced; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - pathology; Deglutition Disorders - etiology; Deglutition Disorders - therapy; dysphagia; endoscopic palliation; Esophageal Neoplasms - complications; Esophageal Neoplasms - pathology; Esophageal Stenosis - complications; Esophageal Stenosis - pathology; Esophagoscopy; Female; Humans; Male; malignant oesophageal stricture; Middle Aged; Retrospective Studies; self-expandable metal stents; Stents
• ISSN: 0004-8682; 1445-2197
• DOI: 10.1046/j.1440-1622.1999.01661.x

Background: The use of self‐expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated. Methods: Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self‐expandable metal stents for malignant dysphagia. Six patients had concurrent tracheo‐oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance. Results: Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2 ± 0.7 to 1.8 ± 0.9 (P < 0.05) after implantation. All tracheo‐esophageal fistulas were successfully occluded. Upon a median follow‐up of 8 weeks (range: 2–20 weeks), 30 complications developed in 21 patients (tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo‐esophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)). Median survival was 13 weeks (range: 1–82 weeks). Conclusion: Self‐expandable metal stents provide useful palliation in patients with incurable malignant dysphagia.